Musculoskeletal ultrasound of the elbow
- David J Berkoff, MD, FAAEM, CAQSM
David J Berkoff, MD, FAAEM, CAQSM
- Professor of Orthopedics and Emergency Medicine
- Department of Exercise and Sport Science
- University of North Carolina Chapel Hill
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
The elbow is susceptible to a variety of injuries and conditions. Due to the relatively superficial location of a majority of the elbow structures, many of these pathologic conditions can be assessed using ultrasound (US).
This topic will review a standard, systematic approach to musculoskeletal ultrasonography of the elbow. Topics devoted to conditions and injuries involving the elbow and upper extremity are found separately. (See "Evaluation of elbow pain in adults" and "Elbow injuries in active children or skeletally immature adolescents: Approach" and "Epicondylitis (tennis and golf elbow)" and "Ulnar neuropathy at the elbow and wrist" and "Radial head and neck fractures in adults" and "Evaluation and management of condylar elbow fractures in children" and "Epicondylar and transphyseal elbow fractures in children" and "Evaluation and management of supracondylar fractures in children".)
USES, ADVANTAGES, AND LIMITATIONS OF ELBOW, WRIST, AND HAND ULTRASOUND
Musculoskeletal ultrasound (US) uses high frequency sound waves (1 to 20 megahertz, MHz) to produce high-resolution images of soft-tissue structures (eg, nerves, tendons, muscles, ligaments, bursae) and bony surfaces. The basic physical principles and underlying technology of US are reviewed in detail separately. (See "Basic principles and safety of diagnostic ultrasound in obstetrics and gynecology".)
US has many advantages over other imaging modalities, including portability and rapid diagnosis . Many of these general advantages are discussed separately. Specifically for the elbow, advantages include dynamic imaging of the ulnar collateral ligament medially and the ulnar nerve at the cubital tunnel; visualization of soft tissue abnormalities, including tendon tears and the typical changes associated with tendinopathy; ligament and muscle injury; bony injury; and identification of an elbow joint effusion [2-6]. (See "Musculoskeletal ultrasound of the shoulder", section on 'Uses, advantages, and limitations of shoulder ultrasound'.)
ELBOW ANATOMY FOR ULTRASOUND EVALUATION
A general discussion of the clinical anatomy of the elbow is provided separately. (See "Evaluation of elbow pain in adults", section on 'Anatomy'.)
- Smith J, Finnoff JT. Diagnostic and interventional musculoskeletal ultrasound: part 1. Fundamentals. PM R 2009; 1:64.
- Tagliafico AS, Bignotti B, Martinoli C. Elbow US: Anatomy, Variants, and Scanning Technique. Radiology 2015; 275:636.
- De Maeseneer M, Marcelis S, Cattrysse E, et al. Ultrasound of the elbow: a systematic approach using bony landmarks. Eur J Radiol 2012; 81:919.
- De Maeseneer M, Brigido MK, Antic M, et al. Ultrasound of the elbow with emphasis on detailed assessment of ligaments, tendons, and nerves. Eur J Radiol 2015; 84:671.
- Ferreira FB, Fernandes ED, Silva FD, et al. A sonographic technique to evaluate the anterior bundle of the ulnar collateral ligament of the elbow: imaging features and anatomic correlation. J Ultrasound Med 2015; 34:377.
- ESSR. Musculoskeletal Ultrasound Technical Guidelines II. Elbow. www.essr.org/html/img/pool/elbow.pdf (Accessed on August 17, 2016).
- USES, ADVANTAGES, AND LIMITATIONS OF ELBOW, WRIST, AND HAND ULTRASOUND
- ELBOW ANATOMY FOR ULTRASOUND EVALUATION
- ULTRASOUND EXAMINATION OF THE ELBOW
- Anterior elbow
- Lateral elbow
- Posterior elbow
- Medial elbow
- SONOGRAPHIC PITFALLS AND APPEARANCE OF ELBOW PATHOLOGY
- ADDITIONAL ULTRASOUND RESOURCES
- SUMMARY AND RECOMMENDATIONS